Hypoxic and Reperfusion Injury Overview

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Questions and Answers

What is a primary consequence of high levels of free radicals in cells?

  • Oxidative stress and cell injury (correct)
  • Increased immune function
  • Enhanced DNA replication
  • Activation of anti-apoptotic proteins

Which type of free radical is classified as a reactive nitrogen species?

  • Hydroxyl radical
  • Superoxide radical
  • Hydrogen peroxide
  • Nitric oxide (correct)

Which molecule is classified as an endogenous antioxidant enzyme?

  • Peroxiredoxins (correct)
  • Glutathione
  • Vitamin C
  • Vitamin E

What triggers the process of apoptosis?

<p>Withdrawal of hormones or growth factors (B)</p> Signup and view all the answers

What happens to apoptotic bodies after cell death?

<p>They are ingested by neighboring cells and phagocytes. (C)</p> Signup and view all the answers

Which of the following diseases is NOT associated with free radical injury?

<p>Diabetes mellitus (C)</p> Signup and view all the answers

Which of the following antioxidants is dietary?

<p>Vitamin A (A)</p> Signup and view all the answers

What is a feature of apoptosis compared to necrosis?

<p>It is characterized by cell shrinkage. (B)</p> Signup and view all the answers

What process leads to altered cell metabolism and function in hypoxic injury?

<p>Decreased oxygen delivery to tissues (A)</p> Signup and view all the answers

Which of the following is NOT a consequence of hypoxia on cellular ATP production?

<p>Increased sodium-potassium pump activity (C)</p> Signup and view all the answers

What is a potential consequence of reperfusion injury?

<p>Formation of reactive oxygen species (C)</p> Signup and view all the answers

What causes free radical formation in the body?

<p>Absorption of extreme energy sources (D)</p> Signup and view all the answers

Which mechanism is directly affected by hypoxia in cells leading to injury?

<p>Decreased energy available for sodium-potassium pumps (A)</p> Signup and view all the answers

Which inflammatory mediator is released by white blood cells during reperfusion injury?

<p>Nitric oxide (A)</p> Signup and view all the answers

What happens to intracellular calcium levels as a consequence of oxidative stress during reperfusion?

<p>Calcium levels increase (B)</p> Signup and view all the answers

Which condition does NOT contribute to the development of hypoxic injury?

<p>Hyperventilation causing increased oxygen levels (B)</p> Signup and view all the answers

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Study Notes

Hypoxic Injury

  • Lack of oxygen in tissues leads to altered cell metabolism and function.
  • Causes:
    • Decreased oxygen content in the blood (hypoxemia).
    • Decreased oxygen carrying capacity of blood (anemia).
    • Decreased blood flow to the tissue (ischemia).
  • Consequences of decreased oxygen delivery to the cell and anaerobic metabolism:
    • Decreased ATP production.
    • Altered Na+/K+ pump function.
    • Altered Ca2+ pump function.
    • Decreased protein synthesis.
    • Cellular swelling.
    • Build-up of lactic acid.
    • Release of intracellular enzymes.
    • Increased intracellular Ca2+ levels.

Reperfusion Injury

  • Cell injury occurring when hypoxic tissue is reperfused after > 60 minutes of hypoxia.
  • Factors contributing to reperfusion injury:
    • Oxidative stress: Formation of reactive oxygen species (ROS) (i.e., free radicals).
    • Ca2+ release: Excess intracellular Ca2+ causes cell injury.
    • Inflammation: Release of inflammatory mediators that can cause cell injury (NO, IL-1, TNF, etc), and ROS.

Free Radical Injury

  • Free radicals are molecules with an unpaired electron.
  • Causes of free radical formation:
    • Absorption of extreme energy sources.
    • Endogenous, usually oxidative, reactions from normal metabolic processes.
    • Inflammation.
    • Enzymatic metabolism of exogenous chemicals or drugs.
    • Other sources: cigarette smoke, alcohol, pollution, transfats, heavy metals, etc.
  • Types of Free Radicals:
    • Reactive oxygen species (ROS): Hydroxyl radical (OH-), superoxide radical (O2-), nitric oxide-derived peroxynitrite (ONOO-), hydrogen peroxide (H2O2).
    • Reactive nitrogen species (RNS): Nitrogen dioxide (NO2), nitric oxide (NO).
  • Effects of Free Radicals:
    • Low/moderate levels: Essential for cell metabolism and immune function.
    • High levels: Causes 'oxidative stress' and cell injury.
      • DNA damage.
      • Fragmented proteins.
      • Lipid peroxidation.

Clinical Examples of Free Radical Injury

  • Free radical injury and aging.
  • Free radical injury causes disease:
    • Cancer.
    • Cardiovascular disease.
    • Pulmonary disease.
    • Neurodegenerative diseases.
    • Ocular disease.

Molecules that Inactivate Free Radicals

  • Endogenous antioxidant enzymes: Superoxide dismutase, catalase, peroxiredoxins.
  • Non-enzymatic Antioxidants:
    • Dietary: Vitamin A, Vitamin C, Vitamin E.
    • Glutathione.

Cell Death: Apoptosis

  • Programmed cell death.
  • Signals that induce apoptosis:
    • Extracellular signals: 'death ligands', withdrawal of hormones/growth factors, toxic agents, etc.
    • Intracellular signals: Decreased number of anti-apoptotic proteins + production of pro-apoptotic proteins.
  • Mechanisms of apoptosis:
    • Nucleus condenses and cell shrinks.
    • Activation of intracellular enzymes (caspases) that breakdown structural proteins and DNA.
    • Apoptotic bodies are ingested by neighboring cells and local phagocytes.
  • Note: No activation of the inflammatory response.

Clinical Examples of Apoptosis

  • Apoptosis during embryonic development.
  • Apoptosis in cancer cells.

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